Hall of Heroes Nomination

Your Information (Nominator)

Your Full Name *

Your Email Address *

Your Phone Number *

Your Relationship to Nominee

Inductee Information

Last Name *

First Name *

Middle Name/Initial

Suffix

Highest Rank Obtained *

Serial/Service Number

Status *

Living

Deceased

📍 Address Information

Present Street Address

City

State

ZIP Code

County of Residence

Email Address

Daytime Phone

Cell Phone

Madison County Connection

Madison County Resident for Last 3 Years?

Born in Madison County?

Address at Time of Entry into Armed Forces

Entered Service as Madison County Resident?

U.S. Military Service

Check all that apply

Army

Navy

Marine Corps

Air Force

Coast Guard

Space Force

Regular

Reserves

National Guard

Periods of Service (Check all that apply)

Service Dates *

Enter the period of military service

Unit/Division

Specific military unit or division served in

🏅 Medals & Awards

Enter the number of each medal awarded (leave blank or 0 if not applicable)

Medal of Honor (Army)

Medal of Honor (Navy, Marines, Coast Guard)

Medal of Honor (Air Force)

Distinguished Service Cross

Navy Cross

Air Force Cross

Silver Star

Distinguished Flying Cross

Soldier's Medal

Navy and Marine Corps Medal

Airman's Medal

Coast Guard Medal

Bronze Star Medal with "V"

Air Medal with "V"

Army Commendation Medal with "V"

Navy Commendation Medal with "V"

Air Force Commendation Medal with "V"

Coast Guard Commendation Medal with "V"

Please list all other individual medals awarded (Example: Purple Heart)

Please list all other awards, decorations, medals, ribbons, or badges not already listed

📝 Nomination Details

Please provide detailed information about why this person deserves recognition

Reason for Nomination *

Maximum 2,000 characters. Be specific and provide examples.

Additional Supporting Information

Optional. Maximum 1,500 characters.

Optional Information

Information submitted by (if other than the applicant)

Name

Daytime Phone

Cell Phone

Address

Email Address

Spouse Information

Name

Daytime Phone

Cell Phone

Email Address

Supporting Documents

Are copies of each Valor Citation attached?

Yes

No

Are copies of Orders attached?

Yes

No

Are photographs or pictures available?

Yes

No

Remarks Please use this space to clarify information that was not already noted elsewhere on form

Upload Supporting Documents

Multiple files supported: You can select multiple files at once or add them one by one.
Accepted formats: PDF, Word documents, images (JPG, PNG, GIF), text files
Size limits: 10MB per file, 50MB total
Examples: Valor citations, military orders, DD214, photos, newspaper articles, award certificates, letters of recommendation

Nominee Contact Information (if available)

Nominee Email

Nominee Phone

Nominee Address

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